Latest / HKB Uncut | A Cosmetic Surgery Podcast / 24. Smaller Breast Implants, Faster Recovery with Dr. Trent Douglas | Is the Preservé® Technique Right for You?

Transcript

24. Smaller Breast Implants, Faster Recovery with Dr. Trent Douglas | Is the Preservé® Technique Right for You? · HKB Uncut | A Cosmetic Surgery Podcast

0:00
SPEAKER_03: Here's the thing, these implants are not going to last forever.
0:02
SPEAKER_03: And that's a shame, right?
0:03
SPEAKER_03: But it is what it is.
0:04
SPEAKER_03: We all know that.
0:05
SPEAKER_03: We like to tell our patients that they're buying themselves another surgery in the future.
0:09
SPEAKER_03: However, if we can give them a smaller device to give them the look that they want that's going to last a little bit longer, I think we would do that all day long.
0:24
SPEAKER_03: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
0:28
SPEAKER_02: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance and what you need to know before you book a procedure.
0:38
SPEAKER_02: I'm Dr.
0:39
SPEAKER_02: Bill Cortesis.
0:40
SPEAKER_02: And I'm Gorov Baharty.
0:42
SPEAKER_02: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
0:50
SPEAKER_03: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
0:58
SPEAKER_03: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
1:22
SPEAKER_02: Today we're going to talk about uh preserve.
1:24
SPEAKER_02: I know this is a technique that you really like, Trent.
1:26
SPEAKER_02: We we've also enjoyed and loved this technique as well.
1:29
SPEAKER_02: And uh let's just get into it.
1:31
SPEAKER_02: Bill, you want to kick it off?
1:32
SPEAKER_03: Yeah, I think it's an amazing technique.
1:34
SPEAKER_03: Um, love it.
1:35
SPEAKER_03: You and I both got introduced to uh kind of Motiva, the company, breast implant company, many, many years ago.
1:43
SPEAKER_03: Um we met the uh um CEO and founder of Motiva.
1:48
SPEAKER_03: We we loved him, his vision for the company, and we loved the product itself.
1:54
SPEAKER_03: And we couldn't wait to get into the into the United States to actually try in our own patients.
2:00
SPEAKER_03: We were one of the first to do kind of a minimally invasive technique, and this is a continuation of that minimally invasive technique.
2:08
SPEAKER_03: And I I think it it's great for a certain subset of the population, and I'd love to get into the nuances behind the preservate technique and why you like to use it, Dr.
2:19
SPEAKER_03: Douglas.
2:21
SPEAKER_01: Yeah, thanks, Bill.
2:22
SPEAKER_01: Um, I I think it's one of those things that, as you mentioned, is going to be a little niche or a subset of our patient populations.
2:29
SPEAKER_01: And I think what's really important for people to realize is that we've been doing a traditional breast augmentation technique for many years very successfully.
2:36
SPEAKER_01: So this is not necessarily out that to replace all of those breast augmentations out there.
2:42
SPEAKER_01: It's very uh well-defined, probably about 15, maybe 20% of your population that comes in for consultation might be a candidate for preserve.
2:51
SPEAKER_01: So it's not going to be taking over your volume, it's gonna be a nice little well-defined subset of folks who are looking for a very subtle enhancement, uh, probably smaller framed and starting with not as much breast tissue.
3:05
SPEAKER_01: And I think we just booked our tenth one here in Knoxville today.
3:10
SPEAKER_01: So the people are finding it out there.
3:12
SPEAKER_01: They're coming in asking for this technique.
3:15
SPEAKER_01: And true to the uh marketing, and I think JJ and Manuel and all the guys uh down in Costa Rica really hit the nail on the head when they say when you're offering this, it's gonna unlock the doors to some people that maybe haven't thought about breast augmentation or maybe haven't thought about coming in for this.
3:32
SPEAKER_01: And now that there's a less invasive technique, it's preserving the natural breast structures.
3:38
SPEAKER_01: I think some folks who might not have been thinking about that small, subtle enhancement are suddenly interested, and we're seeing them in the office.
3:45
SPEAKER_01: Who who is the ideal candidate for it?
3:49
SPEAKER_01: I would say somebody who's uh noliparous, hasn't had any kids, is not breastfed, has a good quality skin envelope, and is somewhere in that uh more petite frame range, uh in that five foot to maybe five four, five five range, with that A or small B cup breast starting, and they're looking for something that's gonna fit their frame, they're looking for proportionality.
4:13
SPEAKER_01: We see out there on social media these days the term ballerina boobs, and I think that's what we're seeing.
4:19
SPEAKER_01: People that want that natural enhancement, they don't want the big, top-heavy, round, full profile look.
4:25
SPEAKER_01: Uh, so they're they're in that 150 to 315cc range of implants.
4:32
SPEAKER_01: And I use one of the analogies when we're talking about the mini, the demi, and the full profile.
4:38
SPEAKER_01: When you're doing that sizing with the rings, which is different than our traditional uh biodimensional approach, what we see is I call that their their shoe size, that little ring that fits.
4:49
SPEAKER_01: I call that their shoe size.
4:50
SPEAKER_01: And then the mini is like uh good keeping with the shoe analogy, uh, the mini is like a flat, the demi is like a three-inch heel, and the full is like a six-inch heel.
5:00
SPEAKER_01: So that's that's terms most of our patients can all all understand and they grasp that and are like, okay, I get that.
5:06
SPEAKER_01: And there's gonna be those ones that are like, oh yeah, I'm a demi or a flat, and then there's gonna be everybody's got them in their office.
5:12
SPEAKER_01: Yeah, I want the six-inch heels.
5:14
SPEAKER_01: Uh, so I think that gives a nice little talking base for what people can expect and how to really tease out of them what their true aesthetic goals are.
5:23
SPEAKER_02: You know, one of the other things too is important is that so there is a whole subset of people who are not really looking to have a breast augmentation.
5:31
SPEAKER_02: And I think the term augmentation is just a just a garbage term.
5:34
SPEAKER_02: It just sounds so synthetic.
5:36
SPEAKER_02: Even our our what we call plastic surgery, we do so much more than plastic surgery.
5:39
SPEAKER_02: We do aesthetic and regenerative surgery is what we really do.
5:42
SPEAKER_02: And so what I the reason why I'm saying that is there's so many patients that'll come in that'll have they're like, I'm wearing this bra.
5:48
SPEAKER_02: I just want, I just want to fill this.
5:49
SPEAKER_02: I don't want my bra to be gaping open.
5:51
SPEAKER_02: And so, really, what you're doing is you're just literally, sometimes you're not even changing their cup size.
5:55
SPEAKER_02: You're literally just volumizing or adding back to what's there.
5:58
SPEAKER_02: And like, so a lot of us are using this word kind of enhancement, just kind of getting them to where they need to be, or maybe where they were before they had kids.
6:05
SPEAKER_02: And the other is like people don't want to the women are busy, women are working, women are professional, women are our bosses, they're doing big things and like they don't have the time to be down and out for a long time.
6:17
SPEAKER_02: And so there's some that are like, listen, I got a little window, or I cannot do this under general anesthesia.
6:23
SPEAKER_02: And with this technique, I mean, you can do this very effectively.
6:27
SPEAKER_02: I've done it several times under full local anesthesia, and um, I think that's interesting.
6:32
SPEAKER_03: That's why I personally like it.
6:33
SPEAKER_03: And it can be done under local anesthesia for for the folks that are afraid to go under general anesthesia.
6:39
SPEAKER_03: They want a little enhancement, they want that core projection what we talk about, right?
6:43
SPEAKER_03: They just want a little bit of enhancement.
6:45
SPEAKER_03: I think it's an amazing procedure.
6:47
SPEAKER_03: It works remarkably well, and it can be done full local without any sedation, and patients tolerate it extremely well.
6:55
SPEAKER_03: You know, we've been taught to go underneath the breasts.
6:57
SPEAKER_03: You can do it through the armpit if you really wanted to.
7:00
SPEAKER_03: Um, it it does it does work remarkably well.
7:04
SPEAKER_03: Yeah, and what is the typical volume though?
7:07
SPEAKER_03: Can we tell our audience a little bit about what what volume enhancements we are typically doing with this?
7:12
SPEAKER_03: When you're saying small, subtle, you know, one to one to two cup size.
7:17
SPEAKER_03: What are we saying?
7:17
SPEAKER_03: 100 cc's, 200?
7:20
SPEAKER_02: Might have been between 150 and 250-ish.
7:22
SPEAKER_02: I mean, you can go higher.
7:23
SPEAKER_02: What about you, Trent?
7:25
SPEAKER_01: Uh, I think the most common ones we've seen have been in that 215 to 250 range.
7:29
SPEAKER_01: I I haven't done any of the really small ones yet.
7:32
SPEAKER_01: Um, I want to take that by 190, I think was the smallest that we did.
7:35
SPEAKER_01: So it's definitely on the smaller end of the spectrum.
7:38
SPEAKER_01: But I think one of the things that comes into play there is how the Motiva implant is designed.
7:44
SPEAKER_01: So instead of being flat against the chest or the table, it's got that little bit of uh projection that comes off off the base on the back.
7:52
SPEAKER_01: So it does have a little bit more oomph to it uh than the same size in a different manufacturer's implant, just based on the engineering.
8:00
SPEAKER_02: Well, you're right, too.
8:01
SPEAKER_02: You know, you're adding to that, you're right, because there's a it's that oomph, and you get you get more pound for pound fill from their implant, but also because of the pocket, too, right?
8:09
SPEAKER_02: Because of where you're placing this.
8:11
SPEAKER_02: This is like talk about this idea of where this implant really is and how it's interfacing with the breast.
8:16
SPEAKER_01: So I think that traditionally the implants, and you talk about submuscular, dual-plane, subglandular, subfascial.
8:25
SPEAKER_01: And the the preserve technique with the motiva implants, and we're using the ergonomic implants because they have more uh viscoelasticity and they stretch a little bit better through the channel.
8:36
SPEAKER_01: And so when we're doing that, we're preserving, hence preserve the breast tissues.
8:43
SPEAKER_01: And so the the last few that we've done haven't used any Bovey electrocautery, haven't even opened it.
8:49
SPEAKER_01: It's a very safe, consistent, reproducible procedure.
8:53
SPEAKER_01: We use ultrasound guidance for our uh our local anesthesia and injection.
8:59
SPEAKER_01: And so I think this has a a lot of applicability, as you mentioned, Bill, to people that may be a little anesthesia adverse, and there's more rapid recovery.
9:08
SPEAKER_01: We're staying on top of the muscle, we're in that subglandular plane.
9:12
SPEAKER_01: So we're not messing with any of the breastfeeding uh mechanisms, we're not going period or we're not cutting through ducts, we're preserving the anatomy and the function of the breast as a gland as well.
9:24
SPEAKER_01: So I think that we're really on to something.
9:27
SPEAKER_01: And when we go and hear some of our colleagues speak on this who have been working uh like you guys very closely with Motiva, uh, you know, some of them call this a revolution, some of them call this an evolution.
9:41
SPEAKER_01: And I tend to fall more on the evolutionary side of things uh rather than a revolution, because we all know it's gonna be a smaller percentage of our breast enhancement uh patients.
9:52
SPEAKER_01: So when I first was trying to get my mind wrapped around this, and I'll see if you guys had the same experience, I felt like I had to unlearn many things.
10:00
SPEAKER_01: I've just spent the last 20 years mastering of implant placement because with the circummammary ligament, which we're preserving now instead of cutting through and some of our more traditional techniques, that implant is going to sit a little bit higher.
10:15
SPEAKER_01: And then with the engineering of the implant and the volume, it's gonna recruit tissue from more of the lateral and inferior base and give a really nice appearance and nice shape.
10:27
SPEAKER_01: But we are putting that implant a little bit more medially and a little higher.
10:31
SPEAKER_01: And when you ask people where they want volume, they want it a little higher and a little more medial.
10:36
SPEAKER_01: So that's where that implant is gonna start out, and then it's gonna unfold and spread a little bit.
10:42
SPEAKER_01: So it may look a little boxy right out of the gate for the first couple of weeks, but have that patient in for your one-month follow-up, and it's gonna be nice and rounded out, it's gonna look fantastic.
10:52
SPEAKER_01: And for those folks who are a little anesthesia adverse, uh, being able to offer them something under light sedation or even under 100% local, I think is a real game changer for uh for bringing patients into the office.
11:06
SPEAKER_02: And a lot of these cases didn't really hurt anyway.
11:09
SPEAKER_02: Like, you know, if you do a subfascial approach, it's pretty minimal recovery.
11:12
SPEAKER_02: Um, and I even I went into it skeptical, like, okay, well, how different is recovery really gonna be?
11:17
SPEAKER_02: Well, it's really different.
11:18
SPEAKER_02: It just is.
11:19
SPEAKER_02: It's it's they just they really feel phenomenal.
11:22
SPEAKER_02: They don't hurt, and you know, and I've you know performed this on you know, people I know very closely, seen them out at an at something socially, even that evening or the next one, you're just like, oh, this is pretty remarkable.
11:34
SPEAKER_02: Um, and I think that is like they didn't even have surgery.
11:37
SPEAKER_02: Right.
11:38
SPEAKER_02: And and and I think the thing is you said something else, Trent, and this is really I think an important thing to talk about, is like there have been so many concepts and things that we learn as as uh aesthetic surgeons, and um some core principles, and like and then you have this pendulum that's shifting about you know pocket placement, you know, over the muscle, under the muscle, over the muscle, under the muscle.
11:57
SPEAKER_02: And then you have this technique which is gonna buck and and kind of add a little shock to the system for us, and it's been very healthy because it's making all of us think more, it's making all of us kind of re-uh-engineer how we approach a patient and get a result that we want for them.
12:12
SPEAKER_02: And you know, what's interesting too about this company is there's a lot of other stuff coming in pipeline as well.
12:17
SPEAKER_02: You know, there's different devices, there's the Ergo 2s, there's the diamond-shaped Mia device, and there's there's talks of using this actually for buttock enhancement as well, which you know in the US we've we've been devoid of this.
12:28
SPEAKER_02: We've Bill and I've talked about this forever ago that we just need a small buttock, you know, implant where you can get core projection, super small volume, and that you can do in a non-invasive way, it'll change everything from a standpoint of buttock enhancement because so many women and men have flattening buttocks as you get older and they don't want a hard, you know, look like they had an operation, but they people do care about having some of that projection.
12:49
SPEAKER_02: And so I think it's interesting that this is kind of like whether or not you even do this technique, you ascribe to it, it's good that this technique is existing because it gives us another way to approach our patients.
13:00
SPEAKER_02: And I love that.
13:01
SPEAKER_02: I think that has been a very valuable thing for aesthetic breast surgery.
13:05
SPEAKER_02: And I'd love to hear your all's.
13:07
SPEAKER_03: I just always hate in plastic surgery when there's like you have to do it this way, this is the only way to do it, you can't do any other way, blah, blah, blah.
13:16
SPEAKER_03: There's so many people that speak, and Dr.
13:18
SPEAKER_03: Douglas knows this.
13:19
SPEAKER_03: They're like, you have to go submuscular and you have to do dual plane, blah, blah, blah, and you have to do this because of this, that, and the other.
13:25
SPEAKER_03: Well, there's been advances in in surgery, right?
13:27
SPEAKER_03: There's advances in products now with these new products, these new implants, we can sort of we can move placement.
13:34
SPEAKER_03: We we talked about the criteria advancing for when you go on top of the muscle, right?
13:40
SPEAKER_03: Because of these newer devices, the criteria isn't like it was before.
13:44
SPEAKER_03: So, again, there is an evolution around this stuff, and it's all about products and what we have available to us, listening to what our patients want.
13:52
SPEAKER_03: They don't want animation deformity anymore, right?
13:56
SPEAKER_03: And so we're evolving as a society and as surgeons, and we're listening to our patients and we're giving them exactly what they want.
14:03
SPEAKER_03: They don't want huge implants anymore, they don't want animation deformity, and now we have tools and ways to be able to give them exactly what they're looking for and can do it under local anesthesia.
14:14
SPEAKER_03: How great is that?
14:16
SPEAKER_01: Oh, exactly.
14:17
SPEAKER_01: And I I think one of the big things is aesthetic breast surgery, at least in the augmentation world, had gotten a little stale over the last 10, 15, 20 years.
14:27
SPEAKER_01: And this really injects a lot into the conversation.
14:30
SPEAKER_01: It's how many times have we all gone to meetings and you hear many of the same talks by speakers or some of their proteges that come up?
14:38
SPEAKER_01: And you you can go to a meeting every five years and maybe you catch a little pearl or two, but by and large, it was the same topics and the same controversies and the same folks.
14:47
SPEAKER_01: And in the past several years, we've injected talking about the pH 4Bs and some of the internal meshes.
14:54
SPEAKER_01: So that's been a very positive change.
14:56
SPEAKER_01: There's been some innovation around that.
14:58
SPEAKER_01: And I think with the uh Motiva implants, uh, there's also been some innovation.
15:04
SPEAKER_01: It's first time we've had really any innovation in breast implant technology, and at least in my career lifetime of 20 years now.
15:11
SPEAKER_01: So I think that you're exactly right.
15:13
SPEAKER_01: It's making people stop and talk.
15:15
SPEAKER_01: Uh a lot of our colleagues have podcasts, and this is a big topic among many of us in aesthetic surgery right now, is we all want to bring the best things to our patients.
15:25
SPEAKER_01: What is the best implant?
15:27
SPEAKER_01: What is the best pocket position?
15:28
SPEAKER_01: What is the best technique to put the implant in that pocket position?
15:32
SPEAKER_01: And I I remember years ago in residency and training, you know, say what you will about Rod Hester, but he had some good ideas.
15:39
SPEAKER_01: He may have been a little bit ahead of his time in some areas, but we were doing the subglandular gel augmentation back in 2003, 2004 as part of the post-approval study.
15:52
SPEAKER_01: So the concept was there, and it's been there for many years, and he certainly didn't invent it, but we had the wrong implants.
15:58
SPEAKER_01: So we had to buy off on the higher capsular contraction rate, a little bit uh bigger stretch in the lower pole.
16:05
SPEAKER_01: We didn't have it dialed in, but I think it's that kind of thinking that comes along now 20 years later, and we've got the right tools, we've got the right implants, we've got mesh, we have preserve, we have all of these things to really offer our patients a full spectrum of aesthetic breast surgery.
16:23
SPEAKER_03: How do you talk to patients about these options?
16:26
SPEAKER_03: Like, you know, when a patient comes in, hey, you know, how do you approach them?
16:30
SPEAKER_03: Do I do this technique versus the traditional technique?
16:33
SPEAKER_01: I I think part of that is all in the approaches, you know.
16:36
SPEAKER_01: And I have my clinical assistant who goes in and rooms with patients, and she'll kind of give me a little thumbs up as we're going in the room of whether a potential preserve candidate or not.
16:46
SPEAKER_01: And several folks in the last few weeks have come in asking if they're specifically for that, if they're candidates or not.
16:53
SPEAKER_01: So if they come in asking about it, I'll talk to them and say, Yes, you're a candidate, let's go down the preserve pathway, or no, your aesthetic goals might be a little bit different than what preserve can accommodate.
17:04
SPEAKER_01: So let's talk about a more traditional route.
17:07
SPEAKER_01: And some folks, you walk in the room and you just know right off the bat we're not going to have the preserve talk.
17:12
SPEAKER_01: Let's talk about augmentation, enhancement, lift, uh, all of those type of things.
17:18
SPEAKER_01: So I think it's very much a customizable approach and it's finding the right procedures for the right patients for the right reasons.
17:27
SPEAKER_01: And I think one of the things preserve offers for somebody who needs maybe that small little lift is getting the implant in the right position and doing a little modified vertical circumarel or mastopexy with that.
17:41
SPEAKER_01: So I think managing the skin, uh, some excess skin with this preserve technique is gonna be the next frontier of where that technique goes.
17:50
SPEAKER_01: And I think to get back to something you'd said earlier, Bill, uh, with the technology and with Motiva as a company, we've all been down to Costa Rica and we've seen Suleyam and the found factory and where all this stuff is manufactured.
18:05
SPEAKER_01: And I think they've really put a personal touch on all of this.
18:08
SPEAKER_01: They deeply care for people who are listening and don't know the history of JJ and Manuel.
18:14
SPEAKER_01: Their dad was a plastic surgeon and they grew up around this, and they took some of his lifelong uh frustrations with breast uh implants and really made this company.
18:24
SPEAKER_01: And for folks in the U.S., I think one of the things I really try to stress with the patients is that this is not a new company.
18:31
SPEAKER_01: It's been around for many years.
18:32
SPEAKER_01: Motiva is is in 90 different countries, it's worldwide.
18:36
SPEAKER_01: The US was uh one of the last people to get it through FDA approval, and it's been a fantastic implant to add to our toolbox.
18:46
SPEAKER_02: You know, that's a good thing you just said, your toolbox.
18:49
SPEAKER_02: And at the end of the day, you know, our listeners need to know that you know you want your surgeon or your artist or your craftsman, whoever, to have all the tools, all the brushes, all the paints, all the things available to get the best outcome.
19:03
SPEAKER_02: And that that includes these devices, this technique, which is a very innovative novel technique that that pairs well with the device.
19:11
SPEAKER_02: And that includes all the other companies.
19:12
SPEAKER_02: Like, hey, listen, that doesn't that doesn't mean you know, Trent only does this, anything.
19:17
SPEAKER_02: He's not you're not a one-trick pony, right?
19:19
SPEAKER_02: You know how to do a subfascial AG, you know how to do a dual plane og.
19:23
SPEAKER_02: And there's certain patients where a dual plane is going to be the right situation for them, and it's gonna be using a different device from a different manufacturer.
19:30
SPEAKER_02: It could be for multiple reasons.
19:31
SPEAKER_02: And so I think the biggest thing is that, you know, we don't make decisions based on a company.
19:36
SPEAKER_02: We make decisions based on like what a patient really needs.
19:39
SPEAKER_02: But it's important to have companies aligned in the right way and working alongside them because they're trying to bring innovative things that can be better solutions.
19:47
SPEAKER_02: And I think at HKB, that's something we pride ourselves on, you know, health, knowledge, beauty, and like pushing the limit, innovating and bringing new things to our patients, but also not forgetting the things that we learned in the past and using that to go forward.
19:59
SPEAKER_02: And um, I think that's super important, and I know you you believe the same way.
20:03
SPEAKER_02: I mean, Bill, I'd like to get your perspective on that.
20:05
SPEAKER_02: Like how, you know, in regards to, you know, preservate is really interesting, like I told you, because it like sparks us and makes us rethink and also opens the funnel up to people who would never have gotten this.
20:15
SPEAKER_02: You know, how does how has that impacted you and what do you do going forward now?
20:19
SPEAKER_03: You know, I've always described to the the thought process that it is our obligations as glorified technicians to listen to that patient and elicit exactly the goals that they want and and and achieve that with the tools that we have available to us.
20:37
SPEAKER_03: And this this is yet another tool to be able to help us achieve that for those patients.
20:43
SPEAKER_03: Not all implants are created equal, not all sizes are created equal.
20:47
SPEAKER_03: And our goal is to marry the goals that the patient has with the devices that we have available to us and the techniques that we have.
20:54
SPEAKER_03: So the more advances we have in the techniques, the more advances we have in the actual technology itself, the better we can actually help our patients achieve the goals that they want.
21:04
SPEAKER_03: Here's the thing these implants are not gonna last forever, and that's a shame, right?
21:08
SPEAKER_03: But it is what it is.
21:09
SPEAKER_03: We all know that.
21:10
SPEAKER_03: We like to tell our patients that they're buying themselves another surgery in the future.
21:14
SPEAKER_03: However, if we can give them a smaller device to give them the look that they want that's gonna last a little bit longer, I think we would do that all day long.
21:25
SPEAKER_03: And I think this technique allows us to be able to use a smaller device that doesn't have the stresses on the tissues that the bigger devices used to have.
21:34
SPEAKER_03: We can give them more of that look that they want.
21:36
SPEAKER_03: It's potentially less inflammatory of a process for them, not only surgically, but long term.
21:43
SPEAKER_03: And this implant can last longer.
21:45
SPEAKER_03: I think it's amazing, right?
21:46
SPEAKER_03: So I I think it it's giving us additional technology to help us as surgeons achieve the goals of the patient.
21:54
SPEAKER_03: And I I think it's great.
21:55
SPEAKER_03: I think more advances need to come to light, to your point, Dr.
21:59
SPEAKER_03: Douglas.
21:59
SPEAKER_03: I You know, things haven't changed too much, right?
22:02
SPEAKER_03: And it's been tried and true.
22:03
SPEAKER_03: And it's like it's great to have newer things, newer us to push a little bit, figure out, hey, how can we help our patients a little bit better?
22:12
SPEAKER_01: Right.
22:13
SPEAKER_01: And I I think one of the things, and you mentioned it, uh, Dr.
22:16
SPEAKER_01: Baharty, was uh HKB and looking as as a practice or as a group of practices.
22:23
SPEAKER_01: And one of the things that makes me feel really good about being part of this, of course, being over in the Knoxville office, is that we all have a wide armamentarium of tools.
22:32
SPEAKER_01: We have energy devices in the office, we offer surgery, we have aestheticians.
22:37
SPEAKER_01: So we the way I really approach things is making it a partnership between myself and the patients with the practice.
22:44
SPEAKER_01: And if they're not quite ready for uh a facelift or breast augmentation, they may need to baby step into something else, maybe a cool peel or soft wave or uh some injections with Melissa.
22:56
SPEAKER_01: So I think having that full spectrum of tools at all of our locations really helps ensure that we're not treating everything like uh when all you when all you have is a hammer, everything starts to look like a nail type mentality.
23:11
SPEAKER_01: We do have all of these things at our disposal.
23:13
SPEAKER_01: So I think that gives us uh really an opportunity to make those correct recommendations for the right people at the right time and really make them part of the HKB family long term and keep them coming back as a happy, satisfied patient.
23:28
SPEAKER_03: I think you both mentioned this, and I think one of the the pillars of Motiva, and I think what got them to the point of creating this device was around the concept of women's health.
23:39
SPEAKER_03: And I think we need to really, and it's one of our pillars, right?
23:42
SPEAKER_03: And you mentioned that, G, is health knowledge beauty is like we really got to hone in on what is in the best interest of that patient long term.
23:50
SPEAKER_03: And I think that's what these implant companies are now looking at, where before they're just trying to make implants and put them as many patients as possible.
23:57
SPEAKER_03: They're like, no, let's really dive in deeper and look at the health of that patient and how can we help that the best way possible.
24:05
SPEAKER_01: Well, and I think the other thing too is how society has trends in the way things go.
24:10
SPEAKER_01: So in facelifts in the last five to seven years, we've seen a trend towards more natural approach, less taut.
24:17
SPEAKER_01: We don't nobody wants that really pulled look anymore.
24:19
SPEAKER_01: People want to see themselves in the mirror, uh, but look a little bit more refreshed, a little bit younger.
24:24
SPEAKER_01: And I think what we're seeing on social media and a lot of these trending uh items are smaller implant sizes, natural proportions.
24:33
SPEAKER_01: But I think back in the in the 90s and early 2000s when I was coming up, and it was bigger, always go bigger.
24:40
SPEAKER_01: And so I think that trend was sustained for many years, and people wanted the bigger implant.
24:47
SPEAKER_01: And how how big an implant can you put in my breast?
24:50
SPEAKER_01: And I think we're trending away from that.
24:52
SPEAKER_01: It's not so much what's the biggest implant, but what's the right implant and what's the right implant manufacturer that makes that implant that's going to get you the result because all of them have slightly different sizes, profiles, and so I personally I like the Motiva uh catalog of implants, but there are some gaps in there, and so you need to know what those gaps are so you can meet the needs of your patients that if you do need another manufacturer's implant, you know the go-to and you've had experience with those other implants, and you feel very comfortable using whatever technique may be necessary to get that patient that outstanding result.
25:28
SPEAKER_03: I think there's been the shift.
25:30
SPEAKER_03: I agree with you, like we're you know, people are going smaller, but I think there's been the shift for lifestyle, right, with our patients, especially, you know, our female patients want an augmentation, right?
25:41
SPEAKER_03: Lifestyle, wellness, fitness.
25:44
SPEAKER_03: It doesn't match with a big implant anymore.
25:47
SPEAKER_02: Right?
25:47
SPEAKER_03: All those characteristics of the lifestyle match with a smaller implant, to your point.
25:51
SPEAKER_02: And it may not match with you know being under the muscle as well.
25:54
SPEAKER_03: Right.
25:54
SPEAKER_03: And so, like, I think that's where this fits a little bit is like, hey, we can get you a smaller natural look, smaller implant, give you that core projection, and it can be done under local anesthesia.
26:06
SPEAKER_03: Are you seeing that in your patient population, G?
26:08
SPEAKER_02: Yeah, you know, a lot of them are honestly just people there that just want like this, they just want a little.
26:12
SPEAKER_02: They want a little, and when we go talk about fat grafting, you have them try on a little insert, you know.
26:17
SPEAKER_02: You know, Bill Bill taught me this, you know, if you you know, if a patient wants to get fat grafting, or is like, I don't want an implant, I just want a little bit of volume, and they're a thin patient, you know.
26:25
SPEAKER_02: If you have them try on a 75 to 150cc insert, like you know, all right, well, then you're not gonna get that just with fat grafting.
26:31
SPEAKER_02: So that that immediately says you need an implant, then they're like, oh, implant, oh, I don't know.
26:35
SPEAKER_02: But now if you can have a way where you can have a small device in there and do it in a way that's not disruptive, because a lot of people just don't want recovery, a lot of people don't want people to know.
26:45
SPEAKER_02: I mean, how many?
26:46
SPEAKER_02: I mean, I mean so many people there are like, I don't want anybody to know.
26:49
SPEAKER_02: I just want a little bit of fill.
26:50
SPEAKER_02: I'm fine with nobody knowing.
26:52
SPEAKER_02: And then the other piece is just the the disruption.
26:54
SPEAKER_02: I'll tell you, like, this is a little bit of a tangent, but it was kind of uh eye-opening to me.
26:59
SPEAKER_02: And I remember I was talking to Anna Steve about this in New York about some patients because she's done it also, where you do patients under when you do it under a less level of sedation or you do it under local, it's almost like this, like when you do it and they get done.
27:11
SPEAKER_02: Like I I've done lots of local surgery, you have too, but like they're just like amazed, and they're just like so, so thankful.
27:18
SPEAKER_02: And it's like and maybe it's just because it's like you know, the breasts, and there's a level of femininity and and and self, you know, self-awareness and like confidence associated with it, but like, man, it's like a pretty powerful thing when you can do something like that, and like they can still go on being um, you know, a mom or being a professional or being, you know, there they could do they can do anything that anybody could do, and they're they're able to get back to that really quickly and not have this crazy recovery.
27:43
SPEAKER_02: And and I give it, I know the subfascial is not bad, the submuscal is not a bad, but there is a recovery.
27:48
SPEAKER_02: And this one is like a fraction of that.
27:51
SPEAKER_02: I think that's interesting.
27:52
SPEAKER_01: I'll tell you guys a good story.
27:54
SPEAKER_01: This is one of my preserve patients from uh about three or four weeks ago.
27:58
SPEAKER_01: Identical twin sister uh had her breast augmentation done elsewhere first with a uh dual plane, so under the muscle.
28:06
SPEAKER_01: And then the the other twin came to me, saw her, she was a good candidate for preserve, and had a completely different recovery experience.
28:15
SPEAKER_01: And I think it's where we are in society, and certainly people looking for more luxury items, aesthetic surgery, things like that, so much of it is experiential.
28:24
SPEAKER_01: And so we want to provide that high level of care, offer the premier procedures like preserve.
28:30
SPEAKER_01: And the twin that I did was out at a concert the next night after her surgery, and she uh she her sister was so jealous.
28:38
SPEAKER_01: She's like, How did you get this recovery?
28:40
SPEAKER_01: I didn't get that.
28:41
SPEAKER_01: Uh and so I think that was a really neat one.
28:44
SPEAKER_01: I'm probably never gonna see that again, like with identical twins getting breast dogs like a month apart.
28:49
SPEAKER_01: Uh, but I but I thought it was a good story and really demonstrates the power of that technique, which is faster recovery, less invasive, getting people back to the gym in two weeks instead of four to six.
29:02
SPEAKER_01: So I I think there's a lot to it.
29:04
SPEAKER_01: And I I think what you said, G, was really spot on as far as so many professional women don't want to take the downtime.
29:11
SPEAKER_01: They have hard enough time finding a little time to come in for an appointment to get set up.
29:15
SPEAKER_01: They don't want to have that uh you know, week of downtime being out of the office or away from the kids.
29:22
SPEAKER_01: So doing something that's less invasive with better and faster recovery.
29:26
SPEAKER_01: I I like doing things that make sense.
29:28
SPEAKER_01: This is one of those things that once I saw it, unlearned a few things, and then got my mind wrapped around.
29:34
SPEAKER_01: I was like, this completely makes sense.
29:35
SPEAKER_01: So I really bought into it.
29:37
SPEAKER_03: But I will tell you though, the subfascial breast augmentation does have a limited recovery as well.
29:42
SPEAKER_03: Yeah.
29:42
SPEAKER_03: You know, and just want to be out there for our listeners, you know, a day recovery at most, you can go out and do your normal stuff.
29:49
SPEAKER_03: This is just a new nuance of that above the muscle technique that is very similar.
29:54
SPEAKER_03: You're preserving the breast tissue, but a good old subfascial breast augmentation is a very limited recovery for patients as well.
30:02
SPEAKER_03: So to that point, G, is there somebody that you would say I'm not doing preserve on if they came in and asked for it?
30:09
SPEAKER_02: Yeah, you know, I think a couple of things.
30:10
SPEAKER_02: I think if they have uh uh challenging topography, topography means kind of the the the surface anatomy of their chest wall.
30:16
SPEAKER_02: If there's a lot of, you know, you know, if there's a huge chest wall asymmetry, sometimes I would I would stay away from that.
30:22
SPEAKER_02: Big asymmetries I'd probably stay away from.
30:25
SPEAKER_02: If they've had multiple surgeries in the past, maybe they're not a you know a primary case.
30:29
SPEAKER_02: Um that's not to say you can't use it.
30:30
SPEAKER_02: And listen, all the plastic surgeons listening, like these are our tools.
30:34
SPEAKER_02: We get to decide how we use them.
30:35
SPEAKER_02: But I'm saying from a standpoint of how you want to utilize it.
30:38
SPEAKER_02: I think if there's a big amount of tois and you know you're gonna be dealing to a to an augmentation lift, you could you could use preserve or not, or you can just use traditional techniques.
30:47
SPEAKER_02: Here's the interesting thing though.
30:49
SPEAKER_02: When you think about that, it's like, well, why don't I just I'm using collar, I'm using stuff, why don't I just open a pocket?
30:53
SPEAKER_02: Well, the interesting thing about preserve is that you could, in theory, have a targeted volume enhancement.
30:58
SPEAKER_02: And everybody who gets a mastopexy and a lift and implants wants the implants up here.
31:04
SPEAKER_02: We're doing everything we can to get them up here and putting mesh in there and doing all this stuff.
31:07
SPEAKER_02: So the idea is, well, what about using this technique here and not have to use mesh?
31:10
SPEAKER_02: Yep.
31:11
SPEAKER_02: And so actually, it's paradoxical.
31:13
SPEAKER_02: It actually does work for some of those cases.
31:15
SPEAKER_02: So I would say that, you know, the ideal case, just like what Trent said, so we don't have to repeat that.
31:20
SPEAKER_02: But I think in other cases, then you think about what value is this technique going to bring me, or does a traditional technique work?
31:27
SPEAKER_02: Other is just volume.
31:28
SPEAKER_02: If the volumes are high, you know, you may not want to use it.
31:31
SPEAKER_02: I'm sure we're gonna be able to push the envelope and change and do what we need to, because that's what we all do, you know, in our pursuits.
31:37
SPEAKER_02: What would you say is the the limitations to not use it?
31:40
SPEAKER_01: I think if skin quality is one, so if there's poor skin quality, uh if they're gonna need a lift, if they're gonna have to lower the fold uh too much on one side or the other, I think those are things that as we all gain more and more experience with this, it is gonna evolve.
31:55
SPEAKER_01: We are gonna see the next generation of uh the balloons come out.
31:59
SPEAKER_01: We are gonna be able to expand a little bit more, we are gonna be able to put some uh some more implants in.
32:04
SPEAKER_01: And as things continue to evolve from the company standpoint, they've already got Ergo 2 in Europe and South America, I think.
32:11
SPEAKER_01: So we'll eventually get that in the States as well and add that to the toolbox and then add MIA, uh, which I think is another interesting technology.
32:20
SPEAKER_01: So I think as things continue to happen, we've got a great conversation going on in our uh in our uh aesthetic society and in uh the specialty right now about all of this.
32:32
SPEAKER_01: So I think it's really, really little bit of a fire under a lot of us who have done uh aesthetic breast surgery for many years now.
32:40
SPEAKER_01: So we are talking, we're not uh not just kind of sitting there waiting to see what's gonna happen.
32:45
SPEAKER_01: We're part of the part of that evolution right now.
32:48
SPEAKER_01: And I think that's where HKB is is early uh adopters and users of the technique.
32:53
SPEAKER_01: Uh, we are gonna have some some substantial experience over the next several years to be able to really be part of this.
33:00
SPEAKER_02: It's super exciting.
33:01
SPEAKER_02: We didn't even toot um our horn about you know the the positions that you hold um within our um specialty in society.
33:10
SPEAKER_02: You know, you're the Dr.
33:11
SPEAKER_02: Douglas is gonna be president of the American Society of Aesthetic Plastic Surgery, which is the premier aesthetic surgical society in the entire world.
33:19
SPEAKER_02: And um, he'll be up for that here coming up soon.
33:22
SPEAKER_02: And we also have one of our other surgeons, you know, um Mindy Hawes, who's uh um ex-president.
33:27
SPEAKER_02: So we have some incredible talent here, and you're we're so grateful that you're part of this organization and helping propel it forward and offering people um in the East Tennessee and greater um Tennessee area and you know, Virginia, um Kentucky area as well, um incredible care.
33:43
SPEAKER_02: You know, I you're you're you're so awesome.
33:45
SPEAKER_02: It's been amazing getting to work with you, and um we can't wait to spend more time with you, and we'll see you in a in a little while up at ASAPS itself.
33:53
SPEAKER_01: Uh I just celebrated my one-year anniversary with HKB in Knoxville this week.
33:57
SPEAKER_01: So that's been uh been fantastic and loved every minute of it.
34:01
SPEAKER_01: It's been fan uh, I mean, absolutely amazing, and we've got a great staff here in Knoxville.
34:05
SPEAKER_01: We're doing wonderful things and look forward to continuing to just wait till the expansion, my man.
34:10
SPEAKER_03: It's gonna be it's gonna be worth it.
34:12
SPEAKER_01: Yeah, wait till the wait till the uh the people in Knoxville see what's coming up.
34:16
SPEAKER_01: Floor plan right there on my desk.
34:17
SPEAKER_01: Oh, yeah.
34:18
SPEAKER_01: I love it.
34:20
SPEAKER_03: Well, we appreciate your time tonight.
34:21
SPEAKER_03: Thanks for joining us on this podcast.
34:23
SPEAKER_03: We can't wait to have you on future ones.
34:25
SPEAKER_03: I know today was kind of limited to kind of just talking about the preserve technique and and some of the challenges and nuances around that, but we look forward to talking to you about more topics in our field, and thank you for all the sacrifices you give for the society and the the greater um you know aesthetic world out there.
34:44
SPEAKER_03: So we definitely appreciate that.
34:47
SPEAKER_02: No, my pleasure.
34:48
SPEAKER_02: Happy to do it.
34:49
SPEAKER_02: All right.
34:49
SPEAKER_02: Well, if you enjoy this episode, please give us some feedback.
34:52
SPEAKER_02: And if you have any ideas for other topics, please comment on our platforms.
34:59
SPEAKER_03: Thank you for listening to HKB Uncut.
35:02
SPEAKER_03: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
35:06
SPEAKER_02: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.